Total Knee Replacement Total knee replacement (TKR) is performed for the relief of pain arising from a knee with advanced arthritis. It is a very commonly performed procedure, but is a major operation, and should be reserved for those who have pain that interferes with most day-to-day activities that cannot be relieved by taking pain-killers. Total knee replacement is an extremely successful operation, and relieves the pain and stiffness that arises from an arthritic or worn out knee joint in at least 95% of cases. The Operation Knee replacement surgery can be performed under either general or regional anaesthesia, and these options can be discussed with your anaesthetist prior to surgery. Once the anaesthetic has been administered, a 15 to 20 cm incision is made down the front of the knee, and the arthritic or worn out surfaces of the knee joint are removed and replaced by the artificial knee components. The back of the knee cap is not always resurfaced, but may be if it is particularly badly worn or damaged. The skin is closed with a dissolvable stitch, and although the scar is in a conspicuous area, it heals nicely and usually fades to a barely noticeable white line. It is important to understand that total knee replacement is not a minimally invasive procedure, although in the future this may be possible as new implant designs and computer-aided surgery become available. After a short period of observation in the recovery area you will be transferred back to the ward, the whole procedure taking about two hours. Total Knee Replacement BEFORE SURGERY Total Knee Replacement AFTER SURGERY Your Stay in Hospital Total knee replacement is a major operation and there is always some swelling, discomfort and bruising afterwards which will steadily improve over the first few weeks. The medical and nursing staff will ensure that you are as comfortable as possible, and will get you out of bed to start standing and walking the day after your operation. You will start with a walking frame under the supervision of a physiotherapist, who will give you instructions and show you exercises that you should continue once you return home. It is very important in the early stages to work hard to get the knee bending as much as possible, and you should expect to regain more than 90 degrees of knee bend within the first couple of weeks. You will have an X-ray taken of the knee, which you can look at and discuss with your surgeon, and by the time you are discharged (about five days after surgery) you will be walking comfortably and safely with two sticks or crutches which you should continue with for the next six weeks. You should be able to go up and down stairs one at a time, get yourself to the lavatory and on and off the bed independently, although you may need some help with shopping and other domestic tasks. If you live alone and are worried about how you will manage after your operation you should discuss this at your initial consultation so that arrangements can be put in place. Outcome of Surgery You will be reviewed by your surgeon at six weeks after surgery, and as long as there are no problems you will be encouraged to start walking without sticks or crutches, and should be able to return to driving. You may gradually increase your level of activity and should be able to return to normal activities, within the next six to nine months, although vigorous activities and impact sports might cause the knee to wear out more quickly and should really be avoided. Patients are often concerned that they will "wear out" their TKR. This is actually an unusual occurrence, with approximately 90% lasting at least 10 years, and 80-90% lasting at least 20 years. The younger or heavier the patient, the greater the chance that the knee will wear out and require revision surgery. The outcome of revision surgery is rarely as reliable as that after the original knee replacement, and for that reason, a TKR is not normally recommended for those under 50-60 years of age.